Nurse Clinician RN


Warrendale, PA

What you'll be doing

The nurse clinician, is responsible for reviewing escalated clinical criteria review for the provider, member, and patient client advocate within the prior authorization/utilization management department. Identify and track, trend for analytic reporting to ensure clinical criteria program integrity. Maintain a professional and ethical behavior at all times as outlined by the nurse practice act and applicable company policy. Maintain contact database and respond to member and physician inquiry regarding clinical program. Make recommendation regarding escalation of issues, and follow through with escalation process. Acts as liaison between client, patient, and patient care advocate to provide guidance on clinical criteria. Perform initial clinical review and analysis of prior authorization case based on state regulation. Special project/assignment as needed.

What your background should be

The ideal candidate should have 2-5 years experience in a clinical setting. Tennessee registered nursing (RN) license required. General PC knowledge including microsoft office, internet and email. Previous clinical criteria review experience preferred; active professional affiliation and national certification in related clinical specialty preferred; able to work flexible work schedule

Required Schooling / Training

Bachelor degree in nursing.

Who is the client company

This is one of the largest pharmacy benefit management (PBM) organization in the United States that provides integrated pharmacy benefit management services including network-pharmacy claims processing; home delivery pharmacy services; specialty pharmacy benefit management, benefit-design consultation; drug-utilization review; formulary management and medical or drug data analysis services to manage drug plans for health plans.
If you are interested in this position, send your resume to